Patient Questions

QUESTION

Is an "Under the Muscle" Breast Implant Really Under the Muscle?

I was told by a plastic surgeon that an under the muscle implant is not actually under the muscle. This is very misleading. I know there are overs and unders and partial unders. Do you have to specify to a doc that you want complete unders?

ANSWER

Breast implants REALLY totally under the muscle

Thanks for your question -

Subpectoral (or under the muscle) breast augmentation is far and away the most common placement of implants for breast augmentation. The reason why is there are several benefits to implants being under the muscle.

There is a lower rate of scar tissue formation around the implantsThe implants are more protected against infection.The implants are better hidden by the extra layer of tissue that comes from subpectoral implantation.

However, many times the implant is not completely under the pectoralis muscle. The muscle itself is a triangular shaped muscle that is broadest at the mid portion of your chest and narrowest at your shoulder. If you draw it on paper you can see that it is quite common for the inferior portion of an implant to not be completely covered by the muscle.

That being said the benefits mentioned above still apply even if your implant is somewhat not under the muscle at the inferior edge.

For small implants many times the implant is completely covered by the muscle.

Breast shape also factors into this. Patients with breasts that are low set or sag somewhat who are not considering breast lift may also have less implant covered by the pectoralis muscle. The answer for this is anatomy - your pectoralis muscle does not significantly change in position as you age... where as your breasts may. Forcing a surgeon to confine a moderate sized or greater implant completely under the muscle will likely guarantee you a very odd shaped breast (a double bubble where the implant is higer than the breast).

In some cases where patients have significant sagging in our San Francisco area practice we actually propose a "dual plane" approach which is a newer technique for capturing the best of both worlds.

It is a complicated question - I hope this helps.

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